1. EMDR for People with Autistic spectrum disorders (asd)
Presented by Caroline Fuidge
EMDR Consultant and trainee trainer

2. Learning objectives Understanding ASD in relation to EMDR
Consider adaption to protocol
Identify potential blocks or obstacles
Improve your confidence with working with this client group
Draw your attention to literature (or lack of literature and encourage research/publication)

3. What do we mean by autistic spectrum disorders?
Consider the common characteristics that you think of when you hear the term ASD
Who have you worked with, what did you need to attend to?
In pairs or threes discuss this with your neighbour (5 mins)

5. Social (Pragmatic) Communication Disorder (May 2013)
Autism
Asperger’s
Social (Pragmatic) Communication Disorder (May 2013)
Impairment in social interaction
Difficulties in social use of verbal and non verbal communication
Impairment in communication
Restricted repetitive stereotyped behaviour
Delay in developmental abnormal functioning prior to age 3
No delay in general language development in childhood or cognitive ability, self help adaptive behaviour or curiosity
May not see it in early development
Clinically significant impairment social, occupational, other domains functioning
Functional limitations: social academic, occupational
Not attributable to other medical or neurobiological condition. Not autism and not intellectual or developmental disability
Autistic Spectrum Disorders: Now covering: autistic/ Asperger/pervasive developmental disorder not otherwise specified
NO LONGER DIAGNOSIS – PREVIOUS ASPERGER’S LABEL = AUTISTIC SPECTRUM DISORDER
Social interaction: non verbals, social interaction facial expression, eye gaze, posture and gesture, developing peer relationships, spontaneous sharing of enjoyment, interests and achivements, lack of social emotional reciprocity
Communication: delay in spoken lang, initiating or sustanting conversations, social or emotional reciprocity, stero typed lang, repetitive, lack of social imitative play
Repetative sterotyped behaviour: preoccupation restricted patterns of interests, inflexible routines and rituals, repetitive/stereo typed motor mannerisms, preoccupation with parts of objects

6. So why do we need therapy?
Vulnerability factors/ experiences/ what kinds of stories do you hear?

7. Core problems of as vulnerabilities within becks cognitive theory
cognitions
mood
behaviours
Events: at risk for multiple negative life evens during all stages of development
Schema: at risk for development of more maladaptive schema about self others and world
Behaviours social skill deficits, poor self management
Mood: emotional regulation dysfunction, sensory dysfunction
Cognitions: social cognition deficits and cognitive rigidity
Events
Schema
Adapted by V Gaus 2007 from Persons, Davidson and Tompkins 2000

8. Therapeutic styles for trauma/anxiety and depression
CBT
Limitations in flexibility
rigid thinking
Lack of abstract thinking
Socratic questioning hard
Motivation for change
Cognitive – top down
Emdr
No need for homework
Working on other systems – cognition not leading
Cognitive restructuring not necessary to compete with rigidity

9. What does the research say?
Ester Leuning 2015: EMDR with Autism: chapter 6: Hans-Japp Oppenheim, Hellen Hornsveld, Erik ten Broeke and Ad de Jongh: Praktijkboek Deel ll Toepasssingen voor nieuwe patientengropen en stoormissen
Donald Kosatka and Celia Ona: EMDR in patient with Asperger’s Disorder: Case report. Journal of EMDR Practice and Research Vo 8 number 1 pg 13-18
Richard Dilly 2014: EMDR in the treatment of trauma with mild intellectual disabilities: a case study Advances in Mental Health and Intellectual Disabilities pg 63-71
Rosanna Gilderthorp 2015: Is EMDR an effective treatment for people diagnosed with both intellectual disability and post traumatic stress disorder? Journal of Intellectual Disabilities vol 19/1
Beth Barol and Andrew Seubert: 2010 Stepping Stones: EMDR treatment of individuals with intellectual and developmental disabilities and challenging behaviour. Journal of EMDR Practice and Research Vol 4 Number 4 pg
L Mevissen, Lievegoed and A de Jongh: 2011 EMDR Treatment in People with Mild ID and PTSD : 4 Cases. Psychiatry Q 82:
R L Brand Flu Congress Psychiatry, EMDR Children with ASD – Abstract only
Sherri Paulson : Edinburgh EMDR Conference: Using EMDR with individuals with Autism

10. Adaptions to the protocol
Have you used EMDR with someone with ASD?
Did you need to do anything different?
Did you struggle with any areas of the protocol?

11. How and why we need to modify the protocol
Information
Processing
Difficulties
Slower info processing
Less capacity of WM
Lack central coherence
Overstimulation/dissociation
Lack generalisation
Emotional dysregulation
Fixed/limited social understanding

12. Complications for us communication, Non verbal

13. Complications for us lack of imagination and arousal

14. Complications for us INFORMATION PROCESSING
Blocked processing
LIMITED WORKING MEMORY
SLOWER PROCESSING
INABILITY TO GENERALISE

15. THINKING PHASES….. PHASE ONE: HISTORY TAKING PHASE TWO: PREPARATION
PHASE THREE: ASSESSMENT
PHASE FOUR: DESENSITIZATION
PHASE FIVE: INSTALLATION
PHASE SIX: BODY SCAN
PHASE SEVEN: CLOSURE
PHASE EIGHT: RE-EVALUATION

16. PHASE ONE: HISTORY TAKING
THINKING TRAUMA HISTORY
TIME LINE
LACK OF SPONTANEOUS INFORMATION
LACK OF UNDERSTANDING AND REPORT OF TRAUMA – FACTUAL ACCOUNTS
DIFFICULT MEMORY - ANYONE ELSE WHO COULD CONTRIBUTE
FIXED STORY
TOO MUCH INFORMATION
LACK OF EMOTIONAL REGULATION WHEN TELLING THE STORY
THINKING TARGET SELECTION

17. PHASE TWO: PREPARTION THERAPY ROOM/ENVIRONMENT – TICKING CLOCK
UNDERSTANDING EMOTIONS AND REGULATING AFFECT
PSYCHOLOGICAL EDUCATION RE: ANXIETY
SAFE PLACE
OTHER INTERESTS AND RITUALS OR ROUTINES
GROUNDING TECHNIQUES – PRACTICAL
TOOL BOX
EXPLAINING EMDR – ABSTRACT CONCEPT/TRIAL MAY BE NEEDED
TYPES OF BI LATERAL – SENSORY CONSIDERATIONS – EM MAY NOT BE PREFERRED, BUZZERS TOO MUCH, TOUCH DIFFICULT, NOISE TOO LOUD
STOP SIGNAL

18. PHASE THREE: ASSESSMENT
DIFFICULTY GETTING AN IMAGE: THINKING ABOUT DRAWINGS, DESCRIBING AS A DVD ON A SCREEN
PHOTO BOOK, CLIPPINGS, STORIES FROM OTHERS, SOCIAL STORIES, COMMIC STRIP CONVERSATIONS
NEGATIVE COGNITION – DOMAINS – CONCEPT OF HOW YOU FEEL NOW COULD BE DIFFICULT
POSITIVE COGNITION – ABSTRACT AND GENERAL CONCEPT DIFFICULT TO IDENTIFY AND RATE WITH VOC
SUDS: LIKERT SCALE DIFFICULT – VISUALLY REPRESENT IT, DESIGN A SCALE TOGETHER

19. PHASE FOUR: DESENSITIZATION
SPEED OF PROCESSING – TAXING WORKING MEMORY
EM’S OR TAPPING – MULTIPLE MAY BE OVERSTIMULATING
FEEDBACK – UNDERSTANDING EXPECTATIONS, INTERPRETING EXPERIENCES CAN BE DIFFICULT, FEEDBACK MAY BE DELAYED.
COGNITIVE INTERWEAVES – MORE DIRECTIVE, LESS SOCRATIC
GOING BACK TO THE TARGET MAY BE CONFUSING OR FRUSTRATING.

20. PHASE FIVE: INSTALLATION
THE THEN AND NOW QUESTION….. HARD TO COMPREHEND
OFTEN FEEDBACK IS, IT JUST IS DONE…. NOT BOTHERING ME… LIKERT SCALES
LACKING GENERALISATION

21. PHASE SIX: BODY SCAN
MAY HAVE MOVED ON – “ITS GONE” “WIPED OUT” “JUST IS”
UNAWARE OF BODY SENSATIONS

22. PHASE SEVEN: CLOSURE
IF YOU NOTICE ANYTHING… TOO MUCH OF AN AMBIGUOUS A STATEMENT
LACK OF GENERALISATION TO CONSIDER
MAY WANT TO TALK ABOUT EXPERIENCE
NOT UNDERSTAND IT WILL CONTINUE OR SEE IMPROVEMENT
“YOU’VE WORKED REALLY HARD” …. ABSTRACT CONCEPT

23. PHASE EIGHT: RE-EVALUATION
LACK OF GENERALISATION
LACK OF SPONTANEOUS INFORMATION- ASK PRACTICALS BASED ON ORIGINAL PROBLEM OR PRESENTATION (IE ARE YOU ABLE TO DRIVE THE CAR NOW WITHOUT CHECKING THE MIRROR LOTS OF TIMES AT THE TRAFFIC LIGHTS?
MEMORY IS DISMISSED EASY AND CLIENT MAY NOT WISH TO REVISIT IT IN ANY DETAIL

24. REGULAR SUPERVISION QUESTIONS
SAFE PLACE
FEEDBACK
TARGET SELECTION
TOUCHSTONE
TRAUMA HISTORY AND RINGFENCING
BI LATERAL FORMS
HOW TO EXPLAIN IT?
SPEED
COGNITIONS
RESEARCH

25. Any Questions?